When every drop counts: a bloodless approach to heart bypass surgery

When Daryl Frame learned he needed open-heart bypass surgery, the diagnosis came quietly after months of what felt like minor discomfort.

"I would occasionally feel a little discomfort in my chest," Frame says. "Nothing severe, nothing alarming."

Cardiac testing later revealed severe blockages in two coronary arteries, including one nearly 80% blocked at a critical branching point which made bypass surgery necessary.

For Frame, a Jehovah's Witness, the decision carried added complexity. His faith prohibits the acceptance of blood transfusions, a factor that can complicate open-heart surgery, where blood loss is common.

"I knew that would be an issue right away," Frame says. "I brought it up immediately. My surgeon was very familiar with treating Jehovah's Witness patients, and that gave me peace of mind."

Precision planning before the first incision

Bloodless heart surgery requires extensive preparation and coordination. According to Reza Salabat, MD, cardiac surgeon and surgical director of heart transplant and mechanical circulatory support, every case begins with careful risk assessment, long before the operating room.

"You have to look at the patient's hemoglobin, their overall health, and ask one fundamental question," Salabat says. "Are you going to help this patient and improve their quality of life?"

While minimizing transfusions is a goal in all cardiac surgeries, bloodless procedures demand heightened vigilance.

"This is open-heart surgery," Salabat says. "You open the chest; there will be bleeding. Every milliliter counts."

To conserve blood, the surgical team uses specialized techniques that allow the patient's own blood to be collected and continuously connected to their circulation throughout surgery, in accordance with their beliefs.

In the operating room, surgeons, anesthesiologists, nurses, and perfusionists work deliberately, recovering blood from surgical sponges, slowing surgical movements, and stopping even the smallest sources of bleeding.

"You take extra time. Extra care," Salabat says. "Every step matters."

Respecting belief while protecting life

Salabat emphasizes that patient autonomy is central to care. "It's their life. It's their body," he says. "My role is to be transparent, give them the facts, and help them make the best decision for themselves."

That approach resonated with Frame, who felt confident going into surgery despite the risks. "I didn't look forward to surgery, but I wasn't overly anxious," Frame says. "I felt at peace with the decision."

Family and faith surrounded him throughout the experience, with loved ones waiting through surgery and daily spiritual conversations during recovery.

A smoother-than-expected recovery

Frame recalls being surprised by how manageable recovery felt. "I was absolutely blown away by how little pain I had," he says. "There was discomfort, but nothing severe. The care team was incredible."

He spent several days recovering in the hospital and soon found himself eager to resume daily life. More than a year later, he says his energy level has significantly improved. He has since adopted dietary changes, reducing red meat, and is focusing on heart-healthy habits.

Benefits beyond belief

Salabat notes that avoiding transfusions can benefit many patients, not only those with religious restrictions. "Transfusions carry risks," he says. "Any time you can safely avoid one, it's better for the patient."

That philosophy guides his approach to all cardiac surgeries. "If this were my family member," Salabat said, "I would want the same level of care."

A message of reassurance

For Frame, the experience reinforced both trust in medicine and gratitude for surgical advances. "The medical profession has made incredible strides," he says. "Letting fear stop you from getting care just doesn't make sense."

He hopes his story encourages others, especially those balancing medical decisions with deeply held beliefs, to ask questions, seek experienced care, and move forward with confidence.

If you're experiencing symptoms like chest discomfort, shortness of breath, or fatigue, or if you're delaying care due to fear or uncertainty, early evaluation can make a difference.
Learn more about heart disease prevention, screening, and treatment at lluh.org/heart-vascular.